Effect of catheter advancement technique on needle tip motion during peripheral intravenous insertion

Background: Failure to successfully place a peripheral venous access device, also known as a peripheral intravenous catheter, impacts patient care, safety, and satisfaction. While factors like catheter size and insertion angle have been well studied, limited research has examined the influence of catheter advancement techniques on needle tip movement, a key determinant of successful placement and patient outcomes. This study measured needle tip movement during the initial advancement of the catheter off of the needle with three different techniques. Methods: In this prospective, within-subject crossover study at a single academic medical center, 78 clinicians each performed nine 18-gauge catheter advancements in randomized order, three per technique, into a hand phantom using one-handed self-advancement, two-handed self-advancement, and two-person advancement. Six-degree-of-freedom electromagnetic trackers (0.2 mm spatial resolution) captured needle tip kinematics and catheter advancement. Metrics measured were straight-line displacement, path length, maximum excursion, and the axial and radial components of motion for the first 1 cm of catheter advancement off of the needle. Results: Two-handed self-advancement yielded the lowest displacement (1.98 ± 1.14 mm), path length (3.93 ± 2.54 mm), and excursion (2.33 ± 1.21 mm). One-handed advancement produced larger displacement (2.54 ± 1.26 mm, p = 0.012), path length (9.23 ± 5.75 mm, p < 0.001), excursion (3.44 ± 1.70 mm, p = 0.002), and radial movement (0.74 ± 0.27 mm, p < 0.001 vs both other techniques). Two-person advancement matched two-handed lateral control but showed greater axial motion (1.65 ± 1.39 mm vs 0.78 ± 1.71 mm, p = 0.001) and slightly higher displacement (2.15 ± 1.17 mm). Participants perceived the highest ease of use and effectiveness was two-handed self-advancement. Conclusions: Two-handed self-advancement minimized unintended needle tip motion during initial catheter advancement off of the needle suggesting prioritization in training curricula. Reducing needle tip motion may lower endothelial injury and intravenous catheter advancement failure, supporting the need for clinical technique studies.